Provider Demographics
NPI:1689558439
Name:JEON, LAUREN MIN (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MIN
Last Name:JEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIN
Other - Middle Name:KYUNG
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17107 STOWERS AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1050
Mailing Address - Country:US
Mailing Address - Phone:714-512-0408
Mailing Address - Fax:
Practice Address - Street 1:17107 STOWERS AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1050
Practice Address - Country:US
Practice Address - Phone:714-512-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical